Without accurate and timely eligibility determination, providers experience countless downstream problems, such as delayed payment, rework (and more rework), low patient satisfaction, billing errors, and (potentially) nonpayment and uncollectible bad debt.
Erroneous plan billing results in the failure to identify out-of-network patients or failure to meet a plan's timely filing requirements. Misunderstanding benefit coverage leads to an inability to identify excluded benefits, assess patient liability, or obtain required pre-authorizations. These operational problems, created by inaccurate eligibility determination, result in patient dissatisfaction and missed financial opportunities.
EligibilityPlus resolves these challenging issues by offering providers the most complete view of patient insurance benefits available in the industry. EligibilityPlus achieves this unprecedented benefit detail by combining standard eligibility Electronic Data Interchange (EDI) transactions with benefits available only on payer web portals.
With a complete understanding of patient insurance benefits, providers can identify specific coverage, simplify patient registration workflows, reduce claim rework, and assess patient liability.
Covers Medicare & Medicaid Too
Government products such as Medicare, Medicare Advantage, and Medicaid are often a large part of a provider’s patient base. The ability to determine eligibility for these patients is essential to identifying which payer has responsibility for payment.
EligibilityPlus provides more data than other eligibility vendors, and every screen is easy to read and easy to understand.
Benefit Eligibility Is A Key to Payment
Accurate and timely patient eligibility data is crucial to a provider's revenue cycle management performance. Identifying patient eligibility and benefit plan details early in the revenue cycle allows for faster patient collections and more accurate claim submission, improving revenue collection and cash flow while reducing administrative expenses. While striving to provide service to patients, providers are confronted with a dizzying array of both payers and benefit plans. If a provider fails to accurately assess specific benefit eligibility, payment is often delayed or forfeited. EligibilityPlus gives providers the tools necessary to collect from payers and patients in a timely and efficient process.
You Decide Which Benefits Are Important
Why try to sort through a long list of available benefits when you can focus on only the benefits for the services you provide? EligibilityPlus can be customdesigned to display the health plan benefits that are most important to you.
The Best Benefit Eligibility Detail in the Industry
EligibilityPlus is designed to give providers real-time eligibility verification and the most comprehensive benefit response available. You need to know more than if a patient is eligible under a particular insurance plan; you need to know the specific benefits for the services you provide. With integrated EDI and Payer web-portal benefits , EligibilityPlus gives you the specific benefits you need to accurately assess and complete eligibility and benefit verification.
More Than EDI
Most clearinghouses process only the EDI eligibility transaction. EligibilityPlus delivers eligibility verification and detailed benefit coverage information to providers using both EDI transactions AND provider payer web-portals.
It's Web-Bot Technology
Most payers have made their web-portal the most complete source of benefit detail, and Recondo Technology web-bot technology gives providers the best of both worlds: eligibility EDI transactions combined with the benefit detail available only on a payer's web-portal. This multi-threaded approach allows EligibilityPlus to produce the most comprehensive eligibility response in the industry.
EligibilityPlus = Patient Eligibility Benefits + YTD Deductible + Out-Of-Pocket Maximum Status
A Complete View of Patient Eligibility
With payer-specific EDI normalization techniques and web-bot technology, EligibilityPlus provides a complete view of the patient's eligible benefits, including YTD deductible and out-of-pocket maximum status, far surpassing any solution offering EDI alone.
Broad Payer Coverage Including Government Payers and Products
EligibilityPlus obtains benefits from any payer that provides a web-portal for providers, or an EDI eligibility response. Since EligibilityPlus provides responses from multiple clearinghouses, providers enjoy the broadest payer coverage available for both commercial and government benefit plans.
Automated Patient Search
- EligibilityPlus dynamically searches all pertinent patient demographics to give you the best chance of finding a match in the payer's eligibility system.
- No Hardware or Software Costs
- EligibilityPlus is delivered via Software as a Service (SaaS), is deployed through a browser, and is delivered over the Internet to your staff. You don't have to buy or install any additional hardware or software
Prevents Incorrect Claim Submission
For instance, Medicare recipients often present as Part A/B beneficiaries when they are in fact eligible under a Medicare Advantage plan. Failure to identify the correct payer may result in a denial or payment delay. EligibilityPlus recognizes if a patient is eligible for Medicare but is enrolled in a Medicare Advantage plan, preventing incorrect claim submission, appeals and the corresponding delay in claim payment.
Unidentified or Missing Insurance?
Why register anyone as a self-pay patient unnecessarily? Too often, particularly in the emergency department, patients have forgotten or are unable to produce insurance information. EligibilityPlus searches multiple payers in real-time, including state Medicaid, to find or identify coverage for self-pay registrations.
Real-time Integration
EligibilityPlus can be integrated into your Practice Management System or Hospital Information System, offering an interactive and integrated processing engine to receive requests and transmit responses in real-time. Integration saves staff time because eligibility and benefit information are posted directly into system notes or the appropriate benefit fields within the insurance section of the patient's account.
Never Lose Eligibility History
EligibilityPlus tracks recent transactions for easy recall and resubmission (if necessary). The EligibilityPlus history feature allows retrieval of eligibility transactions using a variety of search criteria, including patient, guarantor, or other identifiers. Standard EligibilityPlus management reports display valuable information, such as payer utilization and user activity.
EligibilityPlus…
- Increases staff efficiency and productivity and reduces clerical errors and omissions that delay or prevent payment
- Alerting feature makes user aware of important eligibility-related responses such as HMO enrolled, Medicare B only, hospice enrolled, and other payer
- Data can be re-sequenced to display provider-specific benefit detail
- Allows integration of eligibility and benefits inquiries with HIS/PMS
Contact Recondo Technology today to see how EligibilityPlus can give you immediate patient eligibility information and all benefit coverage at registration or point of service.
Brochure in printer-friendly PDF format 